BURNS Flashcards Preview

Where do most burns occur?

Home - Think safety water temp 120F or 48.9C

After a burn many physiological changes occur. Why does plasma seep out into the tissue?

Increased capillary permeability. Occurs in the first 24hrs.Vassels leaking b/c damaged from heat, so vascular vol. decreases can go into shock FVD.

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Why does the pulse increase?

Because any time you have a FVD the pulse will increases, heart rate increases to pump fluid to organs.

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Why does the cardiac output decrease?

Less volume to pump out.

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Why does the urine output decrease?

B/C kidneys are either trying to hold on to fluid of they are not being perfused adequately. Dangerous b/c it only takes 20 min b/f kidney damage can occur.

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Why is epinephrine secreted?

B/C makes you vasoconstrict and shunts blood to vital organs. With a "normal" BP of 120/80, anytime the systolic BP drops below 90, the Pt. will not have adequate organ perfusion. This can be very dangerous.

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Why are ADH and Aldosterone secreted?

To Retain sodium & Water with aldosterone and Retain water with ADH. Therefore, the blood volume will go up!

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What is the most common airway injury with a burn injury?

Carbon minoxide poisoning.

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Normally, O2 binds with_____?.

Carbon monoxide travels much faster than O2. Therefore, it gets to the hemoglobin first and binds. can O2 bind now?

HemoglobinNO - now the Pt. is Hypoxic!

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What treatment is given for airway injury with a burn ?

100% O2-to make sure more O2 is in the race! For this reason it is important to determine if the burn occured in an open or closed space b/c if Pt. inhaled more Carbon minoxide increases the risk of airway injury.

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When you see a Pt. with burns to the neck/face/chest you had better think what?

Airway -monitor breathing problems.

HCP may choose to intubate prophylactically b/c if they wait to long swelling can get worse and wont go down.

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If a Pt. is burned over 40% of their of their body. How do you think this is determined?

The common formula is the "Rule of Nines"

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What is the "Rule of Nines"

It is an estimated of total body surface area affected.-Neck & Head = 9%-Trunk - Front 18% Back 18%-Arm 9% (each) -Leg 18% (each)-Genital Area 1%

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Treatment: For Pt. with burns > 20-25% TBSA includes:

Fluid ReplacementEmergency ManagementMedication Management

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Treatment: Fluid replacement includes?

-Most important aspect of burn management is fluid replacement.-It is important to know what time the burn occured b/c fluid therapy for the first 24 hrs is based on the time the injury occurred, not when the tx was implemented.

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What is the common rule known as the Parkland Rule for calculating fluid replacement for burns?

Calculate what is needed for the first 24hrs and give half the volume calculated during the first 8 hrs.

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Consensus Formula

(4mL of LR) X (body weight in kg) X (%0f TBSA burned) + total fluid requirement for the first 24 hrs after burn.

To calculate fluid replacement properly, you also need to know the Pt. weight in kilograms and TBSA affected. * 1kg = 2.2pds

If the burn Pt. is restless it could suggest 3 problems:

Which of the following would you choose to decide if a Pts fluid volume is adequate?

Their weight or their urine output?

Urine Output:Adult: min 0.5mL/kg/hr outputChild: min 1mL/kg/hr output

Note: in burns its urine output, in other cases its weights

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A Pt. weighing 235 lbs has a 30% total body surface area burn. The HCP order is: Titrate IV fluids to maintain urinary output at 0.5 ml/kg/hr. What is the desired output?Record answer as a whole number ______mls/hr

235lbs / 2.2= 107kg0.5 X 106.8 X 1 = 53.4= 53 mls/hr

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Treatment 2. Emergency Management

A pt. was wrapped in a blanket to stop the burning process. Since the flames are gone, does that mean the burning process has stopped?

Is there more deaths with upper or lower body burns?

Upper

If a Pt. respirations are shallow. You know they are retaining what? Therefore which acid base imbalance will they have?

CO2 Respiratory Acidosis

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Medication management for Burns:How does Albumin help a pt. who is burned?

Albumin hold fluid in the vascular space. Therefore INCREASES vascular volume, cardiac output, blood pressure and kidney perfusion, which all helps to improve FVD b/c we are putting more fluid in the vascular space.* more vol = more pressureNOTE: When albumin in administered everything increases so must monitor for FVE! As the VV increases, the wrk load of the heart increases b/c more vol. to pump. If you STRESS the heart too much pt. could be thrown into FVE. Therefore cardiac output decreases b/c heart is failing. Wet lung sounds are heard b/c if heart isn't pumping blood forward it is going back into the lungs.

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If a pt. is receiving fluids rapidly, was is a measurement you could take hourly? to ensure that you are not over loading the pt.

CVP-looks at Rt. atrial pressure. If numbers increase to quickly the Rt. atrium is failing quickly.

Immunization: Tetanus Toxoid - is what kind of immunity?Active or Passive?

Active immunityit takes 2-4 weeks to develop their own immunity.

Tetanus protectionPassive Immunity - b/c Immune globulin is immediate protection which gives the pt. antibodies. The body does not have to work for the antibodies. Administered by injection.

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Circulatory System:1.What does it mean when a pt. has a circumferential burn on their arm?2.What should you be checking?

1. It means the arm is burnt all the way around.

2. Check for circulation

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If the Pt. vascular check in their arm is bad, what are the names of the procedures to relieve the pressure?

1. Escharotomy - relieves the pressure and restores the circulation, cuts through the escar.2. Fasciotomy - relieves the pressure and restores the circulation, but the cut is much deeper into the tissue: it cuts through the fascia of the muscle.